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DIVISION OF HOSPITAL FACILITIES 
KANSAS STATE BOARD OF HEALTH-TOPEKA Standards 
and 
Regulations for 
Hospitals in Kansas 
(Second Edition) 
KANSAS. STATE BOARD OF HEALTH - • • TOPEKA 
PRINTED BY FERD VOILAND, JR., STATE PRINTER FOREWORD 
The Commission on Hospital Care, an independent nongovern- 
mental committee, recently made an exhaustive study and analysis 
of the hospital situation in this country. The Commission’s report, 
published by the Commonwealth Fund under the title, “Hospital 
Care in the United States,” makes, among many others, the follow- 
ing recommendations: 
“All institutions providing overnight care to the sick 
should be licensed to operate and should be subject 
to periodic inspection by state authority. 
“Hospital licensure law should be used as a means 
to develop an effective, economic, integrated hospital 
service which will adequately supply the public’s 
needs.” 
Although certain phases of hospital care have long been super- 
vised in many states, the movement toward state licensing and in- 
spection of all hospitals is recent and, generally supported by hos- 
pital, medical, and health organizations, has spread rapidly. The 
Kansas legislature adopted a licensure law in 1947, and created an 
Advisory Hospital Council to work with the Board of Health in 
administration of the law. 
The Board of Health accepts the responsibility of formulating 
standards, rules and regulations for hospitals with confidence that 
Kansas Hospital Administrators themselves are, more than any 
others, interested in the efficient and successful operation of then- 
institutions, and are constantly striving to improve their service. 
Such regulations as the Board may make, with the approval of 
the Advisory Hospital Council, are expected to serve as an operat- 
ing guide; and the standards recommended herein are intended 
primarily to remind those who obtain licenses to conduct hospitals 
that vigilance, diligence and a humanitarian attitude are essentials 
in the proper care of patients. 
In adopting these standards and regulations, the Board of Health 
has tried to give due consideration to differences in size, type, and 
resources of hospitals and to make requirements for licensure rea- 
sonable and flexible. 
Executive Officer and Secretary 
Kansas State Board of Health KANSAS ADVISORY HOSPITAL COUNCIL 
John L. Grove, M. D., Newton 
James D. Bowen, M. D., Topeka 
Ray Pierson, Burlington 
Zelma Smith, R. N., Russell 
Herbert Clutter, Holcomb 
Mother Mary Anne, R. N., Wichita 
Charles B. Newell, Kansas City 
Leon Sherwood, Independence 
Irma Law, R. N., Topeka 
F. C. Beelman, M. D., Topeka 
Ex officio Secretary 
R. M. Heilman, M. D., 
Division of Hospital Facilities 
THE KANSAS STATE BOARD OF HEALTH 
G. I. Thacher, M. D., Waterville 
R. T. Nichols, M. D., Hiawatha 
John M. Porter, M. D., Concordia 
J. F. Gsell, M. D., Wichita 
G. R. Hastings, M. D., Garden City 
Hugh A, Hope, M. D., Hunter 
F. L. Loveland, M. D., Topeka 
L. S. Nelson, M. D., Salina 
J. W. Spearing, M. D., Columbus 
William E. Scott, Kansas City CONTENTS 
PAGE 
Purpose of Licensure Law 5 
Standards and Regulations 5 
Institutions to Be Licensed 7 
I. New Construction, Material Alterations, Additions 7 
Sites 8 
II. General Standards 
A. Safety and Sanitation 8 
B. Dietary Department 10 
C. Accommodations for Patients 11 
D. Nursing Department 12 
E. Hospital Records and Reports 14 
F. Provision for Contagious Disease Patients 15 
G. Laboratory Facilities and Practices 15 
H. X-ray Facilities 15 
I. Personnel 16 
III. Special Requirements for Maternity Service 
A. Nursing Service 16 
B. Accommodations for Maternity Patients.... 17 
C. Provisions for the Patient in Labor 17 
D. Provisions for Delivery 18 
Care of Newborn Infants 19 
E. Accommodations' for Infants and Nursery Care 19 
IV. Special Requirements for Mental Hospitals 
A. Personnel 24 
B. Security Measures 24 
C. Restraints 24 
D. Shock Treatment 24 
V. Special Requirements for Tuberculosis Hospitals 
A. Disposal of Sputum 24 
B. Contagion Technique 24 
C. X-ray Department 25 
D. Dishwashing 25 
E. Rehabilitation Facilities 25 
VI. Hospital Standards Developed on a Point System 
Explanation 25 
Point Schedule 26 
VII. Licensure Law 33 
Inquiries addressed to Division of Hospital Facilities', Kansas 
‘ State Board of Health, Topeka, Kansas, relative to regulations or 
to codes, officers, or organizations referred to herein will receive 
prompt attention. PURPOSE 
of the Licensure Law 
An act providing for the licensing, inspection and regulation of 
hospitals and for administrative and enforcement procedures went 
into effect upon publication in the Statute Book, June 30, 1947. A 
copy of the act, which may be referred to as the “Licensure Law,” 
is appended hereto. 
The State Board of ffealth, subject to advice and direction of the 
Advisory Hospital Council, is charged with administration of the 
law. The “Licensure Law” (Chapter 329, Laws of Kansas, 1947) 
sets forth the purpose of the act in Section 2, viz.: 
“To provide for the development, establishment, and enforcement 
of standards: 
(1) for the care and treatment of individuals in hospitals, and 
(2) for the construction, maintenance, and operation of hos- 
pitals, which . . . will promote safe and adequate 
treatment of such individuals in hospitals.” 
The law creates an Advisory Hospital Council, which “shall 
have the following responsibilities and duties: 
(a) To supervise and direct the Licensing Agency (State Board 
of Health) in matters of policy affecting administration of 
this act, and in the development and approval of rules, 
regulations and standards provided for hereunder. 
(h) To review on appeal . . . any order of the licensing 
agency revoking, denying or suspending a license and to 
modify or reverse such order” (Section 11). 
The following “Standards and Regulations” are adapted from 
standards prevailing in many states which have a licensure law 
similar to ours. A large majority of Kansas hospitals have won 
favorable recognition by national medical associations. To them, 
such regulations may appear merely as a reflection of something 
already accomplished. We hope, however, by setting up reason- 
able standards and by raising them in keeping with further ad- 
vances in medical science, to call attention to inadequacies or 
defects in hospital practices and facilities and to furnish a guide 
for constant improvement—all to the end that those who need med- ical care may find safe, comfortable accommodation, and scientific 
and ethical treatment in any Kansas hospital. 
We solicit the active cooperation of Hospital Boards, Medical 
Staffs, Nurses, other Personnel and State Agencies concerned, in 
using the Licensure Law as an aid in attaining and maintaining the 
highest standards of Hospital Service. 
F. C. Beelman, 
Executive Officer and Secretary 
Kansas State Board of Health 
R. M. Heilman, M. D., Director 
Division of Hospital Facilities Standards, Regulations, and Recommendations 
Those parts having the effect of law are printed in boldface type 
Institutions Subject to Licensure Under Chapter 329, 
Laws of Kansas, 1947 
General Hospitals 
Hospitals providing general medical or surgical care. They may or may not 
also provide specialized services such as pediatrics, maternity, and urology. 
Special Hospitals 
Hospitals limiting their services to special types of care, such as tuberculosis, 
orthopedics, pediatrics. 
Hospitals or Homes For the Chronically III or Convalescent 
Nursing homes, rest homes, convalescent homes, or other institutions devoted 
primarily to the maintenance and operation of facilities for the care and treat- 
ment of four or more patients suffering from prolonged illness or defect, or 
recovering from injury or disease and receiving medical or skilled nursing care. 
(Such homes are to be distinguished from institutions which are devoted pri- 
marily to domiciliary care.) 
I. New Construction, Material Alterations, 
Additions 
1. As one of the primary purposes of the Licensure Law is to develop, es- 
tablish, and enforce standards for the construction of hospitals, close co- 
operation between the Board of Health (the licensing agency), the hospital 
management (or owner) and those in charge of such construction (archi- 
tects and contractors) is particularly desirable when new buildings, addi- 
tions or material changes are in prospect. 
Before construction is begun, plans and specifications covering the con- 
struction of new buildings, additions, or material alterations to existing 
buildings shall be submitted to the Board of Health for approval or rec- 
ommendations with respect to compliance with these standards and regu- 
lations. These plans should show the general arrangements of the build- 
ings, including the intended purpose and fixed equipment of each room, 
with such additional information as the Board of Health may require. 
Thereupon the Board of Health will investigate the plans and give notice 
to the proper person of approval or disapproavl with such recommenda- 
tions as it sees fit to make. 
No system of water supply, plumbing, sewerage, garbage or refuse 
disposal for these institutions shall be installed nor shall any such existing 
system be materially altered or extended until complete plans and specifi- 
cations for the installation, alteration or extension, together with such in- formation as the Board of Health may require, have been submitted in 
duplicate and approved. 
Construction should follow approved plans and specifications. It is 
suggested that in order to avoid unnecessary expense in changing final 
plans, proposed plans in sketch form be reviewed with the Board of 
Health as a preliminary step. 
2. Sites for new construction should be selected with a view to both present 
and continuing desirability. Environment, zoning restrictions, accessibility, 
and availability of public utilities' will be taken into consideration in exam- 
ining applications for license. 
II. General 
A. SAFETY AND SANITATION 
1. Cleanliness 
Clean, well-kept buildings are essential. Floors, walls, and ceilings 
should have finishes suitable for purpose for which room serves and 
should be frequently washed, cleaned or painted. Comfortable and 
sanitary living conditions for patients and employes should be main- 
tained. 
2. Fire Protection 
Provision for protection against fire, explosion, spontaneous combus- 
tion, toxic, noxious or irritating gases is essential and must satisfy the 
requirements of the State Fire Marshal, or of existing local agencies 
for fire prevention and fire control. 
3. Heating 
Heating plant shall be adequate to maintain a temperature of 70 de- 
grees Fahrenheit in severe weather, in all rooms used for patients, and 
capable of maintaining a temperature of 75 degrees Fahrenheit in 
nurseries. 
4. Water Supply 
The water supply shall be obtained from a water supply system, the 
location, construction, and operation of which comply with the stand- 
ards approved by the Board of Health. It is recommended that a 
municipal water supply be used if available. The water should be 
distributed to conveniently located taps in the building and hot water 
made available at all times. 
5. Sewage Disposal 
Sewage shall be discharged into a municipal sewerage system where 
such a system is available; otherwise, the sewage shall be collected, 
treated, and disposed of in an independent sewerage system which 
complies with the standards approved by the Board of Health. Dis- 
posal shall be such as to protect against access thereto of rodents, flies 
or other insects, and not to permit untreated discharges of sewage to 
contaminate or intermingle with any flood, surface or ground water. 6. Plumbing 
Toilet facilities in reasonable ratio to the number, type, and sex of 
patients cared for in the institution are necessary. The plumbing and 
drainage, or other arrangements for the disposal of excreta, infectious 
discharges, and institutional waste, shall be designed in such manner 
as will prevent contamination of any water supply, milk or other food 
materials. These standards prohibit the use of any fixture connected 
to the plumbing system that is of such design, or installed in such 
manner, as to permit back siphonage of contaminated products into 
the water lines. 
4 ■ 
7. Garbage Disposal 
All garbage shall be collected, stored, and disposed of in a manner 
that will not permit the transmission of a contagious disease, create a 
nuisance or provide a breeding place for flies. Containers for garbage 
should be water-tight, have tight-fitting covers, and be fly and rodent 
proof. They should be emptied at frequent intervals and be scoured 
and aired before further use. Infectious waste materials shall be 
burned on the premises. 
8. Screens 
When flies, mosquitoes, and other insects are prevalent, all outside 
doors, windows, and other outside openings shall be screened with wire 
screen or its equal, with not less than sixteen meshes per lineal inch. 
All screen doors should open outward where building design permits 
and be equipped with self-closing devices. 
9. Lighting 
Adequacy—Each patient’s room shall be an outside room with a satis- 
factory amount of natural light. The window area should not be less 
than one-eighth of the floor space. All rooms, including storerooms, 
attic, and basement areas in use, should have sufficient artificial light- 
ing facilities so that all parts shall be clearly visible under such artificial 
lighting. 
It is especially important that hallways, stairways, inclines, ramps, and 
entrances be well lighted in order to prevent accidents. 
Lighting fixtures should be selected and placed with a view to the 
comfort and safety of patients and personnel. All service rooms and 
working centers, such as medicine cabinets or nurses’ charting desks 
should be adequately lighted. Type and installation of fixtures in 
operating, anesthesia, and delivery rooms must be such as to minimize 
danger of explosion. Grounded explosion-proof receptacles shall be 
provided. 
10. Emergency Lighting 
Emergency lighting facilities must be provided and distributed so as 
to be readily available to personnel on duty. At no time may open 
flame type of light be used in delivery or operating rooms. Flashlights 
or battery operated lamps, with vapor-proof switches, providing ample 
illumination for surgery, shall be in readiness at all times for use in 
delivery and operating rooms. 11. Ventilation 
Building shall at all times be adequately ventilated. Kitchen, bath- 
rooms, and service rooms should be so located and ventilated by 
window or mechanical means as to prevent offensive odors from enter- 
ing patients’ rooms and the public hallways. 
12. Stairways 
All stairways shall be provided with handrails; open stairways with 
guardrails. Nonslip treads are recommended. 
13. Elevators 
> 
Elevator installation shall comply with local and state codes, if any, 
and with requirements of State Fire Marshal. Passenger cab platforms 
should be not less than 5' 4" X 8'. Doors should be not less than 
3' 10" wide. 
14. Laundry 
The institution shall make provision for the proper cleansing of linen 
and other washable goods. Diapers and other soiled nursery linen 
should be washed separately from each other and from other hospital 
linen. It is especially important that diapers be washed with plenty 
of mild soap, and thoroughly rinsed through four waters to remove all 
soap. 
Where linen is sent to an outside laundry it is the responsibility of the 
institution to visit the laundry selected and determine that work is done 
in accordance with these standards. 
15. Incineration 
Incineration facilities shall be provided for the disposal of infected 
dressings, surgical and obstetric wastes, and other similar materials. 
16. Communication 
There must be a telephone in the building. Telephone extensions or 
other means of intercommunication should be provided. 
B. DIETARY DEPARTMENT 
1. Facilities for Preparation and Serving of Food 
There must be facilities in the hospital for the proper preparation and 
serving of food. Hot, well-balanced meals shall be served regularly. 
2. Food Storage 
(a) Storerooms—Storerooms shall be clean and well ventilated. Stored 
food should be protected from dust, flies, rodents, vermin, unnecessary 
handling, droplet infection, overhead leakage or other source of con- 
tamination. 
(b) Refrigeration—Kitchen facilities shall include refrigeration, and 
perishable food must be kept at a temperature below 50 degrees 
Fahrenheit. It is suggested that there be a reliable thermometer in the 
refrigerator and in the storerooms used for perishable food. 3. Cleansing and Disinfection of Utensils 
All dishes and utensils used in storage, preparation or serving of food 
and drink shall be effectively cleansed, rinsed, and disinfected after 
each usage. Recommended methods of disinfection: 
(1) Immersion for at least 2 minutes in clean water at 170° Fahren- 
heit. 
(2) Immersion for at least one-half minute in boiling water. 
(3) Immersion for at least 2 minutes in lukewarm chlorine bath con- 
taining at least 50 parts per million of available chlorine. (Chlo- 
rine is not recommended for silverware.) 
Results obtained with dishwashing machines should be equal to those 
obtained by the methods outlined above. 
After disinfection, the utensils should be allowed to drain and dry in 
racks or baskets on nonabsorbent surfaces. Drying cloths are not rec- 
ommended. Dishes should be stored in closed cupboards for protec- 
tion against dust and moisture. 
4. Construction of Glass-filling Devices 
Every device for filling water glasses should be constructed so as to 
prevent contact of the upper one-third of the glass with the device, and 
in addition, so that no portion of the device extends into the glass. 
5. Ice 
All ice used in contact with food or drink shall be clear natural ice, or 
ice made from water from a source approved by the Board of Health. 
Before ice is used in food or drinks it shall be washed with water of 
known safety, and handled in such manner as to prevent contaminatior 
by organisms of infectious disease. 
6. Milk Supply 
Grade “A” pasteurized milk must be used if available. When such mihc 
is not available, condensed, evaporated, or dried milk is recommended. 
Every precaution should be taken to assure a supply of safe, good milk. 
(For infants under one year of age see “Preparation of Feedings,” 
page 22.) 
7. Hand-washing Facilities for Food Handlers 
There shall be hand-washing facilities with soap, running water, and 
an adequate supply of towels in all kitchens, including diet kitchens, 
and in washrooms used by food handlers. Use of a common towel is 
prohibited. 
8. Physical Examinations For Food Handlers 
Food handlers shall have an examination for tuberculosis upon em- 
ployment and annually thereafter. 
C. ACCOMMODATIONS FOR PATIENTS 
1. Rooms 
(a) Location—Each patients’s room shall be an outside room with a 
satisfactory amount of natural light and shall communicate directly with a corridor. Rooms extending below ground level shall not be used 
for patients unless the rooms are dry, well ventilated, and otherwise 
suitable for occupancy. 
(b) Room Area—Rooms shall afford not less than 60 square feet of 
floor space per bed with at least 3 feet between beds. Recommended: 
at least 100 square feet in one-bed rooms and 80 square feet per bed 
in multiple-bed rooms. 
(c) Window Area—Window area should not be less than one-eighth of 
the floor area. Half of window area should be openable. 
(d) Doors—Doors to patients’ rooms should open inward and be suffi- 
ciently wide to permit removal of an occupied bed. (3' 10" is recom- 
mended. ) 
2. Furnishings 
(a) Bed—A good bed must be provided for each patient. After dis- 
charge of any patient the bed and bed furnishings, bedside furniture, 
and equipment shall be thoroughly cleaned. 
(b) Bedding—A sufficient supply of clean bedding and bed linen shall 
be kept on hand for use at all times. 
(c) Storage Space—There should be satisfactory storage space for 
clothing, toilet articles, and other personal belongings of patients. 
(d) Privacy for Patients—Screens or suspended curtains shall be avail- 
able for securing privacy in rooms occupied by two or more persons. 
(e) . Signals—Means for signaling attendants shall be provided at the 
bedside of each patient. 
D. NURSING DEPARTMENT 
1. Space Requirement 
There shall be adequate space and facilities for the proper cleansing 
and storage of nursing supplies and equipment. Suitable provision 
must be made for the preparation of medications and treatments. 
Utility rooms should be outside rooms with adequate lighting and 
ventilation. They should be conveniently located for efficient conduct 
of work. 
2. Equipment 
There should be sufficient equipment for nursing care according to the 
type of patients accepted by the institution. The following is not a 
complete list of nursing equipment necessary or desirable for the care 
of patients, but is intended to include certain minimum essentials and 
point out special precautions which must be taken in their use: 
(a) Linen—Individual towels, wash cloths, and bath blankets must be 
provided for each patient. 
Bedpan covers must not be used interchangeably. 
(h) Enamelware—There shall be sufficient number of wash basins, 
mouthwash cups, and bedpans, plainly marked, for the use of each 
individual patient; provided that where enamelware is disinfected or 
sterilized after each using, it need not be kept individual. (c) Thermometers—There shall be a sufficient number of thermometers, 
both oral and rectal, to permit adequate disinfection before using. 
(d) Hot-water Bags—Hot-water bags should be covered before placing 
in beds. The greatest care should be exercised in their use to see that 
water is not too hot and bags are not leaking. If electric heat pads are 
used, they shall be checked periodically by a qualified electrician. 
(e) Restraints—Restraints may be applied only when they are neces- 
sary to prevent injury to the patient or to others, and should be used 
only when alternative measures are not sufficient to accomplish these 
purposes. In applying restraints, careful consideration should be given 
to the methods by which they can be speedily removed in case of fire 
or other emergency. 
3. Storage of Drugs and Medicines 
(a) All medicine, drugs, poisons, and stimulants shall be plainly la- 
beled and stored in a specially designated, well-lighted medicine cab- 
inet, closet or storeroom, and made accessible only to the physician or 
nurse in charge. 
(b) Narcotics must be securely locked and accessible only to the per- 
son in charge. Biologicals shall be kept under refrigeration at tempera- 
ture of 50 degrees Fahrenheit or under. 
(c) Old medications should be discarded, including special prescrip- 
tions for patients who have left the institution. 
4. Sterilization of Supplies 
(a) Sterilizing Equipment—There shall be provision for the proper 
sterilization of dressings, utensils, instruments, and water. 
(b) Check of Sterilizer Performance—It is recommended that a hospital 
adopt a recognized method of checking sterilizer performance, such as 
the use of a fusing control in the largest package of each load, or the 
bacteriological examination, at frequent intervals, of sterilized dressings. 
(c) Storage of Supplies—A cabinet or other suitable enclosed space 
should be provided for keeping sterile equipment and supplies. Special 
precautions must be taken so that sterile supplies may not be mixed 
with unsterile supplies. 
5. Hand-washing Facilities 
(a) There should be adequate hand-washing facilities with knee, foot, 
or elbow control throughout the institution, especially in operating, de- 
livery, labor rooms, and nursery; in examining and treatment rooms; in 
main and diet kitchens; in utility and other service rooms; in toilet 
rooms; and in rooms used for isolation of patients. Lavatories in pa- 
tients’ rooms are desirable. 
(b) Special Features in Connection with Scrub-up Sinks—To be well 
adapted for hand-scrubbing for personnel, hand-scrubbing sinks should 
be designed to make it possible to wash hands easily, comfortably, and 
without breaking technique. 
(1) The lavatory or sink should be at a proper height from the floor. (2) Faucets should be high enough above the basin to permit easy 
hand-washing under running water without touching the sides of 
the basin. Mixing faucets are desirable. 
(3) Running water for scrub-up sinks shall be controlled with a knee, 
foot or elbow operated device. 
(4) A sufficient supply of linen or paper towels shall be constantly 
available so that a fresh towel can be used for every hand-wash- 
ing. Use of a common towel is prohibited. 
E. HOSPITAL RECORDS AND REPORTS 
1. Medical Records 
Accurate and complete medical records shall be kept for all patients 
admitted to the hospital, including a record of admission date, physical 
examination, provisional diagnosis, treatment, prognosis, and nursing 
care. The records of cases involving surgery must show details of pre- 
operative study and diagnosis; name of surgeon and his assistants, type 
of anesthetic and by whom administered; postoperative diagnosis, pa- 
thology, and result. 
Records of newborn infants shall be kept and shall contain the physi- 
cian’s signed report on the physical condition of the infant immediately 
before the infant is discharged from the hospital. 
All hospital records shall be preserved in a permanent file either as 
original records, abstracts, microfilming or otherwise, and should be 
such as to afford a basis for a complete audit of professional service 
rendered and for gathering statistical information. 
2. Physicians’ Orders 
All orders of physicians shall be written in ink or indelible pencil and 
signed by the physician in charge. Such orders shall be preserved on 
the patient’s chart or in the established record of such orders. 
3. Financial Records 
An accurate and complete record of income and disbursement shall be 
maintained. Recommendations of hospital associations regarding ac- 
counting and statistics deserve careful consideration. 
4. Birth and Death Lists 
On or before the fifth day of each month a complete list of births, 
deaths, and stillbirths occurring in the hospital during the preceding 
calendar month shall be reported to the Board of Health with such 
information as the board requires, on special blanks which the board 
will furnish for such purpose. 
5. Birth and Death Certificates 
(a) The hospital shall prepare a birth certificate for every child born 
therein, obtain attending physician’s signature thereon, and forward it 
to the local registrar of vital statistics within five days after date of 
birth. (b) Upon the death of a patient the hospital must promptly prepare 
a standard Kansas certificate of death for the deceased, containing all 
personal particulars, medical certification of cause of death and physi- 
cian’s signature. This complete death certificate will be presented to 
the funeral director or other person authorized by the family to prepare 
the body for interment. 
6. Disposition of Bodies 
Whenever the body of a stillbirth or deceased is to be disposed of in 
any hospital by incineration, preservation or dissection, the hospital is 
legally acting as an undertaker and therefore must comply with section 
134 of the vital statistics law (Ch. 65, Secs. 130-151, G. S., 1935). Such 
compliance involves filing a standard stillbirth or death certificate with 
the local registrar of vital statistics and obtaining a burial-removal per- 
mit before disposing of the body by the aforementioned means. 
7. Unclaimed Bodies 
The hospital, when in possession of a dead body which is unclaimed, 
shall promptly notify the University of Kansas Medical Center, Kansas 
City, Kansas, of such possession. (See Ch. 65, secs. 901-905, inc., and 
Sec. 1706, G. S., 1935, for laws governing use of dead bodies by 
schools.) 
F. PROVISION FOR CONTAGIOUS DISEASE PATIENT 
Hospitals which do not have a specialized contagious disease department 
shall make adequate provision for isolation of patients with contagious 
disease, or suspected of having, or being carriers of contagious disease. 
G. LABORATORY FACILITIES AND PRACTICES 
Hospitals shall provide, as a minimum, adequate space, equipment, and 
supplies for routine chemical and miscroscopic urinalysis; and for complete 
blood count, coagulation time, bleeding time, sedimentation rate and esti- 
mation of hemoglobin. Such facilities should be supervised by a physician. 
Hospitals which do not maintain a laboratory capable of making standard 
hematological, bacteriological, pathological, and chemical diagnostic exam- 
inations under supervision of a competent pathologist, shall arrange to ob- 
tain all such service from a laboratory approved by the Kansas Advisory 
Laboratory Commission. 
All abnormal tissues removed at operation, except tonsils and adenoids, 
shall be examined by a pathologist. 
Complete reports of results of laboratory tests and of examination of tissues 
shall be entered in patients’ records. 
Laboratories performing blood tests for syphilis must be approved by the 
Kansas Advisory Laboratory Commission. 
H. X-RAY FACILITIES 
Adequate space and equipment should be provided for diagnostic X-ray 
and fluoroscopic examinations. X-ray work should be in charge of, or under 
the general supervision of, a licensed physician with training or experience in radiology, who should assume responsibility for film interpretation and 
for proper protection against radiation, electric shock, and combustion of 
stored film. 
I. PERSONNEL 
1. Medical Attendance and Nursing Service 
(a) All persons admitted to a hospital should be under the care of a 
physician duly registered and licensed in Kansas, and authorized by 
the governing body to practice in such hospital. A diagnosis or provi- 
sional diagnosis should be recorded promptly by the physician on all 
persons admitted. Consultation on all serious cases by use of various 
medical staff members should at all times be encouraged. 
(b) No medication or treatment shall be given to a patient except on 
the written order of a physician. When emergency cases are given 
medication upon oral or telephone instructions, the instructions should 
be written into the record. 
(c) In all hospitals which admit two or more doctors to practice there 
should be an organized staff to govern the practice of medicine in the 
hospital and complete records of the proceedings of such organization 
should be maintained. All techniques and procedures involving diag- 
nosis, treatment, and management of the patients should be reviewed 
periodically and subject to change by the medical staff. 
(d) Nursing service should be in charge of a registered nurse, day and 
night. Provision should be made for adequate nursing coverage at all 
times. 
(e) Homes or hospitals for chronically ill or convalescent patients shall 
arrange for one or more regularly licensed physicians to be called in 
emergency. They should have one qualified person, preferably a reg- 
istered nurse, definitely in charge of nursing service. 
{f) All adjunct and specialized services including laboratory, anes- 
thetics, urology, radiology, etc., should be under direction of a qualified 
staff physician. 
III. Special Requirements for Maternity Service 
A. NURSING SERVICE 
Nurses caring for maternity patients and newborn infants should not care 
for other patients. When necessary for the same nurse to care for both 
maternity and nonmaternity patients, isolation technique shall be employed 
in giving nursing care. 
All personnel in contact with patients and all food handlers should be 
examined on assignment and annually thereafter by a physician designated 
by the hospital management, and certified as showing no evidence of com- 
municable disease. B. ACCOMMODATIONS FOR MATERNITY PATIENTS 
1. Segregation of Department 
It is recommended that maternity patients be cared for in a segregated 
part of the hospital. If it is necessary to place maternity patients in 
rooms previously occupied by other patients, rooms and furnishings 
shall be thoroughly cleaned before so used. 
2. Isolation Facilities 
Immediate segregation and isolation of all mothers with infectious, 
fever or other condition inimical to the safety and welfare of others 
must be provided in a separate room. 
3. Patients’ Room 
Rooms for maternity patients must in general conform to the require- 
ments set forth in Section II, C-l, of these standards. The following 
are additional requirements for rooms housing maternity patients: 
(a) Location—All rooms occupied by maternity patients shall be non- 
basement rooms. 
(b) Floor Area—Rooms or wards in which maternity patients are cared 
for shall provide floor space equal to at least 70 square feet per 
patient. There shall be at least 3 feet between beds. 
(c) Privacy—Where two or more patients occupy the same room, pri- 
vacy shall be secured by means of screen or curtains. 
(d) Hand-washing Facilities—If the patient’s room serves as admission 
and preparation room, it shall be equipped with proper hand- 
washing facilities. 
C. PROVISIONS FOR DELIVERY 
1. Room to Be Provided 
(a) It is recommended that a special room be equipped as a delivery 
room. This room must not be used for any other purpose, and it should 
be used only for delivery of noninfected patients. Patients with any 
evidence of infection or possible infection should be delivered in a 
separate room or in a private room. 
(b) If maternity service is very small, it is permissible to use patient’s 
own room provided the room affords reasonable privacy, can be set up 
satisfactorily for delivery, and is thoroughly clean before use. 
(c) The operating room should not be used for delivery with the ex- 
ception of Caesarean section. 
2. Room—Physical Features 
(a) Delivery room shall be of ample size to permit observance of good 
technique. 
(b) Walls and floor must be washable. 
(c) Adequate lighting shall be provided. 
(d) Hand-scrub facilities for doctors and nurses shall be in or adjacent 
to delivery room. 3. Equipment—For Delivery 
(a) There should be a suitable delivery table equipped for operative 
deliveries and treatment of shock. The pad should be protected with 
waterproofed sheeting in good condition. 
(h) Delivery room should be furnished with suitable tables or stands 
for instruments, enamelware, and necessary supplies. 
(c) An adequate supply of enamelware and sterile linen, dressings, 
gloves, and face masks should be in readiness for all deliveries. 
(d) Facilities for administration of oxygen and sterile equipment for 
administration of blood transfusions and intravenous or subcutaneous 
therapeutic solutions must be readily available. 
(e) There shall be ready at all times equipment for general anesthesia, 
and a minimum of drugs and anesthetics ordinarily needed for use. 
(f) A stretcher or carrier must be provided for returning patient to her 
own room. 
(g) There should be a surgical or spot light, a small sterilizer, and a 
clock in the delivery room. All lights should be equipped with ex- 
plosion-proof bulbs. 
(h) There should be a supply cabinet or built-in shelf for sterile pack- 
ages, instruments, suture materials, oxytocic drugs, syringes, and emer- 
gency equipment. 
(i) The same aseptic technique shall prevail as at any surgical oper- 
ation. 
Equipment—For Reception of Newborn Infant 
(a) Heated Bassinet—A heated bassinet, crib or incubator shall be 
ready in the delivery room for reception and care of the newborn infant. 
Provision should be made for keeping the infant warm and protected 
from exposure to infection during transit from delivery room to nursery. 
If the infant is carried by a nurse, he should be wrapped in a warm 
blanket and the nurse should wear a mask and a gown. An elevator, 
when used by an attendant transporting an infant, should be free of 
other passengers. 
(b) Equipment for Resuscitation—There must be equipment for re- 
suscitation as ordered by the physician. Facilities for the administra- 
tion of oxygen shall be available. 
(c) Silver Nitrate Ampoules—Silver nitrate ampoules for the prevention 
of infant blindness shall be kept on hand and instillation of silver nitrate 
shall be done before the infant is removed from the delivery room. 
(d) Identification of Newborn Infants—Every infant shall be marked 
for identification before it is removed from the delivery room by one of 
the reliable methods in common use, such as tape or name beads. In- 
formation shall be sufficient to identify infant with one mother, and 
one only. If written tags are used, ink shall be waterproofed. 4. Provision for Postpartum Mothers 
Immediate Care After Delivery.—The patient shall be under close su- 
pervision during the time when she is recovering from the effects of 
anesthesia and for at least one hour to observe the fundus and to report 
to the physician any symptoms of hemorrhage. 
D. PROVISIONS FOR INFANTS I 
1. GENERAL PROVISIONS: 
(a) Nursery to Be Provided—A nursery shall be provided for the care 
of newborn infants and shall not be used for any other purpose. 
(h) Standard Nursery Defined—The standard nursery is established as 
one that (1) contains no more than 12 bassinets (preferably eight); (2) 
provides 25-30 square feet of floor area for each bassinet, unless parti- 
tioned into cubicles; (3) is equipped with running water for hand- 
washing controlled by knee-, foot- or elbow-operated valves; (4) does 
not communicate directly with any other room used as a nursery or 
with a public corridor; and (5) is located as far as possible from the 
main line of hospital traffic. 
(c) Suspect Nursery Recommended—It is recommended that every hos- 
pital maintaining a nursery shall provide as well a small “suspect” or 
observation nursery for the care of newborn infants who are suspected 
of harboring infection or who have been exposed to actual or potential 
infection. 
(d) Standard Suspect Nursery Defined—The standard suspect nursery 
is established as one that: 
(1) Is entirely separate from the main nursery but on the obstet- 
rical floor or in the maternity unit; 
(2) Contains one bassinet for each 8 bassinets in the main nursery 
but in no case less than‘2 bassinets; 
(3) Provides 20-40 square feet of floor space per bassinet; 
(4) Is partitioned into cubicles; and 
(5) Is provided with running water for hand-washing controlled 
by knee-, foot,- or elbow-operated valves. 
(e) Disposition of Infants Suspected of Illness—It is recommended 
that all infants who arouse suspicion of illness, or who have been ex- 
posed to actual or potential infection, should be housed in the suspect 
nursery until either suspicions are proved unwarranted or a diagnosis 
of disease is made. Responsibility and authority for transfer of an 
infant from the main nursery to the suspect nursery should be vested 
primarily in the nurse in charge of the main nursery at any given 
time. The suspect nursery should be staffed by nurses who do not 
work in the main nursery, and strict isolation technique should be ob- 
served there. The following categories of infants are considered either 
suspected of infection or exposed to potential infection: 
(1) Infants with possible diarrhea, eye or vaginal discharges, 
skin lesions, or premonitory symptoms of upper respiratory 
infection. 
(2) Infants born outside the hospital. (3) Infants born to mothers who have diarrhea or some other in- 
fectious disease, or who develop such during their hospital 
stay. 
(4) Infants subjected to ritualistic circumcision or to surgery other 
than routine circumcision. 
(f) Segregation and Isolation of Infants with Diagnosed Illnesses—Im- 
mediate segregation and isolation of all infants with diagnosed infec- 
tions such as diarrhea, infectious dermatitis, or respiratory infections 
shall be provided in a separate room off the obstetrical floor or outside 
the maternity unit. All equipment shall be kept completely separate 
for each such infant. 
(g) Admittance to Nurseries—No persons other than physicians, 
nurses, technicians, and individuals responsible for maintenance should 
be admitted to any room used as a nursery. Everyone not working in 
the nursery exclusively should put on a fresh cap, gown, and mask 
when entering it, and wash hands. 
(h) Rooming In—Infants may be kept in mothers’ rooms provided in- 
dividual cribs are furnished, visitors are restricted to a minimum, and 
other conditions are satisfactory to the Board of Health. Such rooms 
shall not be considered nurseries unless they contain more than two 
infants, in which case all requirements for an infant nursery shall apply. 
2. Rooms—Physical Features of Nurseries 
(a) Location—The nursery should be an outside room so located as to 
receive sunshine some portion of the day. It should be on the same 
floor as the mothers’ rooms, and conveniently located with reference 
to them. 
(b) Size and Organization—It is recommended that each bassinet 
should constitute an activity unit, and that therefore the entire floor 
space be utilized for the widest possible spacing of bassinet stands. 
Storage space for supplies should be provided in the bassinet stands 
insofar as possible or in individual bedside stands. There should be at 
least 18 inches between adjacent bassinets, with at least 3-foot aisles 
between rows. From 24-30 square feet of floor space should be pro- 
vided for each infant and in no case should there be less than 20 
square feet. 
(c) Handwashing Facilities—Every room used as a nursery should be 
provided with handwashing facilities. Running water should be con- 
trolled by foot,- knee,- or elbow-operated devices. A paper towel dis- 
penser should be provided. The use of a foot operated soap dis- 
penser is suggested. One handwashing sink should be provided for 
each 8-10 bassinets in older nurseries. 
(d) Control of Atmospheric Conditions: 
1. Heating—Heating equipment shall be sufficient to maintain a 
temperature of 75 degrees Fahrenheit in the coldest weather. 
Any room used for the care of infants should be provided with 
a reliable room thermometer near the cribs and approximately 
at crib level. 2. Cooling—Cooling equipment should be provided of sufficient 
capacity to maintain a temperature of 75 degrees Fahrenheit in 
the hottest weather. 
3. Humidity—Relative humidity should be maintained between 
30-50%. The provision of an instrument for measuring humid- 
ity is desirable. 
4. Air Movement—It is recommended that equipment be pro- 
vided that will assure at least eight complete air changes in the 
nursery every hour in all types of weather. Glass deflectors, or 
other effective window ventilators, are recommended as pro- 
tection against dust and drafts. A complete air conditioning 
system, thermostatically controlled, which will automatically 
provide for heating, cooling, humidity, and air movement is 
highly recommended. 
(e) Walls, Floors and Ceilings—Walls and floors must be washable. 
Ceilings should be washable as well, and preferably should have ac- 
coustic treatment. Dry sweeping or dusting in nurseries is prohibited. 
{f) Viewing Windows—A glass observation window is recommended, 
fitted with a shade or Venetian blind. 
(g) Anteroom—No room used as a nursery should communicate di- 
rectly with a public corridor. The anteroom that is therefore required 
may serve several useful purposes: 
(1) It should be equipped with handwashing facilities and space 
for storage of gowns for the use of personnel entering the 
nursery. 
(2) It may serve also as a chart room and “control” station for 
the use of nurses. 
(3) If a Dutch door, provided with a shelf or tray, opens from 
the anteroom into the nursery, physicians may examine in- 
fants without actually entering the nursery. 
3. Furnishing and Equipment 
(a) Bassinets—A separate crib or basket shall be provided for each 
infant. Cribs shall have firm mattresses, covered with waterproof 
sheeting and washable pads. Washable inside linings must be provided 
to obviate danger of injury to infants from crib bars and as a pre- 
ventive measure against the transmission of infection except when 
one-piece plastic bassinets are provided. Freshly laundered linings, 
blankets, and linen shall be furnished for each new occupant. The pro- 
vision of “unit” cribs which contain built-in table tops for washing and 
storage space for the infant’s supplies is recommended. The use of 
racks or bassinet stands' which hold more than one bassinet should be 
prohibited. 
(b) Common Tables Disapproved—The use of common bathing or 
dressing tables should be prohibited as a preventive measure against 
transmission of infection. All bathing, diaper changing, and treat- 
ments should be carried out in the bassinet. (c) Individual Thermometers—One rectal thermometer shall be pro- 
vided for each infant. Thermometers shall be kept in antiseptic solu- 
tion in individual containers. 
(d) Other Individual Supplies—Individual bottles of oil (if oil is used), 
individual washbasins (if daily baths are given) and an individual 
24-hour supply of linen should be provided for each infant and stored, 
with the thermometer, in the bassinet stand. 
(e) Scales—Accurate scales must be provided; the weighing pan 
should be freshly covered for each infant. 
(f) Bottle Warmer—A separate utensil, preferably a self-contained 
electrical apparatus, should be provided for warming infant formulas. 
(g) Diaper Cans and Linen Hampers—In each nursery there shall be 
at least one covered metal container for soiled diapers, with foot con- 
trol pedal and removable paper or other lining which can be disposed 
of or laundered. In each nursery there should be at least one linen 
hamper with removable liner for soiled linen other than diapers. 
(h) Incubators—Incubators suitable for the care of premature infants 
shall be provided in the ratio of at least one incubator to 20 bassinets 
or fraction thereof. 
(i) Hot-water Bags—If hot-water bags are used, they must be en- 
closed in a protective covering before being placed in the crib. Elec- 
trical heating pads shall not be used in cribs of infants. 
(;) Clock—A large wall clock, visible from all parts of the nursery, 
should be provided. 
4. Preparation of Feedings 
(a) Formula Room—There shall be a special area for the preparation 
of milk mixtures, equipped with a sterilizer, sink, handwashing facil- 
ities, and storage space. This area should at least be out of the line 
of traffic, and is preferably enclosed as a separate room. 
(h) Refrigerator—There shall be a refrigerator of a size in keeping 
with capacity of nursery equipped with a thermometer capable of 
holding a 24-hour supply of individually bottled milk mixtures. A 
temperature of 40-45 degrees Fahrenheit should be maintained in it. 
It should be used for formulas exclusively. 
(c) Care of Bottles, Caps, and Utensils—Bottles, caps, and utensils 
used in the preparation of milk mixtures shall be thoroughly washed 
and rinsed before each use. Feeding equipment from infected or sus- 
pected infants shall be sterilized before being returned to the milk room. 
(d) Care of Nipples—Nipples shall be thoroughly washed, rinsed, and 
sterilized by boiling before each use. 
(e) Preparation of Feedings—Feedings should be prepared by a regis 
tered nurse or dietitian, who is preferably gowned and masked and 
who adheres to a scrupulously clean technique. All formulas and 
fluids offered to newborn infants (or other infants under the age of 
one year) shall be prepared by the following method, known as termi- 
nal or post sterilization: Milk mixtures and other fluids offered to infants shall be poured 
into clean individual bottles at the time of preparation. A steril- 
ized nipple shall then be attached to each bottle and covered with 
a cap of paper, metal or glass so constructed that the nipple is 
completely enclosed. The entire unit shall then be subjected to 
terminal sterilization with steam, under pressure of not less than 
6 pounds 110 degrees Centigrade or 230 degrees Fahrenheit) 
for not less than 10 minutes, or by flowing steam at a temperature 
of not less than 100 degrees Centigrade (212 degrees Fahrenheit) 
for not less than 30 minutes. The temperature of the formula or 
fluid, as determined by periodic testing, shall be not less than 93 
degrees Centigrade (200 degrees Fahrenheit) at the end of the 
heating period. 
(f) N on-autoclavable Feedings—Fruit juices and formulas containing 
soybean products, meat, cereal or lactic acid may be offered without 
such terminal heating, but shall be prepared with and stored in pre- 
sterilized equipment. 
5. Nursing Service 
(a) Nurse-Infant Ratio—Nursing care should be provided day and 
night in the ratio of at least 1 nurse for each 12 infants (preferably 8). 
(b) Graduate Nurse Requirement—At least one graduate nurse should 
be assigned to each room used as a nursery at all times, day and night. 
If the nursery census falls below 6 infants, she may properly give care 
to noninfected obstetric patients on the floor, provided that she ob- 
serves isolation precautions (cap, gown, and mask) with one of her 
two classes of patients. 
(c) Advanced Training of Nurses—At least one graduate nurse as- 
signed to the nursery should have had advanced training in the care 
of full-term and premature infants at some recognized teaching center. 
(d) Use of Auxiliary Workers—Auxiliary workers should not work in 
the nursery except under the close and immediate supervision of a 
registered nurse in the maternity division. 
6. Clothing and Linen 
(a) Clothing—Infants’ clothing should be furnished by the hospital. 
Freshly laundered or disposable diapers only should be used, and 
should be available in the necessary quantity. When the infant is dis- 
charged, clothing furnished by its parents should not be brought into 
the nursery. 
(b) Laundry—Nursery linen should be washed separately from other 
hospital linen, and carefully protected from contamination after laun- 
dering. Clean receptacles only should be used to return nursery linen 
to the maternity department. Diapers should be washed in plenty of 
mild soap and thoroughly rinsed through four waters to remove all 
soap. They should not be washed by nurses assigned to the nursery. 
7. Exceptions to Certain Requirements 
Exceptions may be made to the majority of the above provisions which 
have the effect of law (printed in boldface type) in connection with bona fide research and experimentation in the medical or nursing as- 
pects of nursery operation. Such departures from standards should be 
cleared through the Division of Maternal and Child Health of the 
Board of Health and should not be carried out any longer than will 
serve a useful purpose. 
IV. Special Requirements for Mental Hospitals 
A. PERSONNEL 
The staff of a mental hospital or general hospital with psychiatric service 
should include a physician who is qualified by training and experience to 
direct the care and treatment of patients afflicted with mental illness. 
Psychiatrists and other personnel, trained in therapies used in the care 
or treatment of the mentally ill, should be proportionate to the number of 
patients as recommended by the American Psychiatric Association. 
B. SECURITY MEASURES 
Hospitals admitting and treating mentally-ill patients shall take every 
reasonable precaution for the security of patients and personnel, such as 
providing lockable doors and windows, screens or bars, shatter-proof glass, 
suitable room furnishings, etc., and exercising due diligence in keeping 
drugs, narcotics, objects and materials which might be used for homicidal 
or suicidal purposes inaccessible to patients. 
C. SECLUSION, RESTRAINT 
Patients shall not be placed in seclusion or in mechanical restraint ex- 
cept on written order of the physician in charge. 
D. SHOCK TREATMENT 
Shock treatment shall be given only by persons who are designated by 
the governing body or director as being adequately trained or instructed 
in such treatment. 
V. Special Requirements for Tuberculosis Hospitals 
A. DISPOSAL OF SPUTUM 
A rigid routine for daily collection of sputum cups and bedside paper 
bags shall be carried out. These shall be burned in an incinerator. 
B. CONTAGION TECHNIQUE 
An approved technique for preventing the spread of infection from 
patient to employes shall be carried out. This applies particularly to the 
nurses giving bedside care, and masks and gowns shall be provided for 
their use. It is especially important that adequate hand-washing facilities 
be provided on all floors. All employes, professional and nonprofessional, 
shall be given pre-employment and annual examinations, including a chest 
X-ray. C. X-RAY DEPARTMENT 
The X-ray department should be located so as to be convenient to both 
in-patient and out-patient departments. 
A written report on each X-ray film taken shall be made and properly 
filed. 
D. DISHWASHING 
It is especially important that approved methods of washing and steril- 
izing dishes be enforced. 
E. REHABILITATION FACILITIES 
Larger sanitoria, generally 200 or more beds, should provide space for 
rehabilitation activities. This should include an auditorium for entertain- 
ment and religious worship, classrooms for instruction, and occupational 
therapy rooms. 
Larger sanitoria should also have a social service department headed by 
a qualified social service worker. 
VI. Hospital Standards Developed on a Point System 
The licensing agency, with approval of the Advisory Hospital Council, has 
adopted a point system to serve as a guide in measuring a hospital’s ability to 
meet requirements for licensure. The schedule of points on the following pages 
is intended to furnish a plan for taking an inventory of what the hospital has 
and what it does to promote the safety and comfort of patients and employes. 
No attempt is made to establish the relative importance of different phases of 
hospital care. 
An increase in bed capacity is usually accompanied by additional and im- 
proved facilities, broadening the field of activity, wider variety of services, and 
greater specialization in care of patients. Therefore, under a point system, the 
number of points needed for licensure will depend largely upon the size of the 
hospital. The table below shows the approximate number of points which gen- 
eral hospitals, according to size, are expected to attain. 
EXPLANATION 
4- 25 beds 
26- 50 beds 
51- 75 beds 
76-100 beds 
101-150 beds’ 
Over 150 beds 
Special Hospitals and Homes for Chronic or Convalescent Patients may rea- 
sonably be expected to meet the same standards as General Hospitals in facil- 
ities and services which are common to all; and correspondingly high standards 
in facilities and services peculiar to each. 
Important: A star indicates a regulation which must be met or a 
standard which must be attained within a reasonable time (see Sec. 8 of 
Licensure Law) to continue operation of a hospital. SCHEDULE OF POINTS 
A. Accessibility Total points 10 
1. Location convenient to doctors, employes and public 2 
2. Parking facilities for staff and visitors 2 
3. Sidewalks or paved approaches to entrances 2 
4. Entrances and grounds adequately lighted 2 
5. No unusual traffic hazards 2 
B. Public Utilities Total points SO 
1. Water supply 5 
2. Sewerage system 5 
3. Electric light and power 5 
4. Public gas supply 5 
5. Fire department 5 
6. Telephone system 5 
C. Environment 
Freedom from annoyance or danger from: Total points 10 
1. Industrial plants, railroads, airports 3 
2. Exposure to outside fire hazards 3 
3. Adjacent fly or mosquito-breeding areas ■ 2 
4. Floods or poor surface drainage 1 
5. Schools, playgrounds, athletic fields 1 
D. Area Total points 6 
1. Sufficiency for present needs 3 
2. Room for expansion 3 
E. Protected by zoning restrictions 4 
Total Points for Part I, “Site” 60 
II. GENERAL 
A. Safety and Sanitation 
1. Housekeping Total points 220 
★ a. Interior surfaces clean and in good condition 5 
Furniture, floor-coverings, equipment, clean and in good con- 
dition 5 
c. Patients’ quarters comfortable and attractive 5 
★ d. Effective measures for vermin and rodent control in use 5 
e. Cleaning equipment adequate and adapted to hospital use. . . 5 
2. Fire Prevention and Control—Safety Measures 
★ a. Meet requirements of state or local authorities 10 
b. Building housing patients rated for insurance as fireproof or 
fire resistive 10 
c. Automatic sprinkler system 10 
d. Special care in handling or storing of combustible or explosive 
materials 5 
3. Heating 
-fa a. Adequate radiation 5 
b. Central heating plant with thermostatic control 10 
I. SITE 4. Water Supply 
it a. From approved source 5 
b. Hot and cold water outlets well distributed 5 
5. Sewage Disposal 
it a. Through approved sewerage system 5 
(Additional if approved municipal system) 5 
6. Plumbing 
it a. Complies with state and local regulations, if any, and with re- 
quirements of State Board of Health 5 
it b. Adequate number of toilets, baths or showers, lavatories, sinks, 5 
7. Garbage Disposal 
it a. Sanitary handling of garbage; infectious waste materials 
burned 5 
b. Facilities for refrigeration of garbage 5 
★ 8. Screens for Outside Openings 5 
9. Lighting 
it a. Patients’ rooms have satisfactory natural light 5 
it b. Artificial lighting adequate in all parts of building, stairways, 
basement, etc 5 
it c. Wiring in good condition—safe installation of fixtures particu- 
larly in operating and delivery rooms 5 
10. Emergency Lighting 
it a. Battery operated lamps or flashlights—no open flame 5 
Or emergency generator or battery system installed to supply 
circuits promptly with current 10 
11. Ventilation 
it a. All spaces for patients susceptible to frequent change of air- 
means of avoiding drafts in patients’ rooms 5 
Or forced ventilation or air conditioning system 10 
b. Exhaust fans in kitchen, laundries, and spaces lacking outlets, 5 
12. Stairways 
it a. Handrails on all stairways; guardrails on open stairways 5 
13. Elevators 
it a. Installation conforming to recognized safety code and to state 
and local codes, if any—regular inspection 5 
14. Laundry 
a. Adequate space, well ventilated, modern equipment, well op- 
erated-sufficient capacity 10 
it Or good commercial laundry service 5 
it 15. Incineration 
a. Equipped to burn infectious waste materials 5 
16. Communication 
it a. Telephone—private line 5 
b. Intercommunicating system 5 17. Engineer 
a. Qualified full-time engineer 10 
Or part time 5 
b. Adequate work and storage space 5 
c. Adequate and safe fuel storage 5 
B. Dietary Total points 70 
1. Supervised by graduate dietitian 15 
★ Or by competent person experienced in such work 5 
2. Prepared daily menus on file 5 
★ 3. Kitchen area adequate—clean—good equipment—well ventilated... 5 
★ 4. Food storage—clean, well ventilated, affording complete protec- 
tion against food contamination—refrigeration 5 
★ 5. Adequate dishwashing and disinfecting equipment and processes 
and means of garbage disposal 5 
6. Sanitary glass-filling devices 5 
it 7. Sanitary handling of ice used in food or drink 5 
it 8. Use of only pasteurized, powdered or condensed milk 10 
it 9. Adequate hand-washing facilities—common towel prohibited.... 5 
it 10. Medical examination of all food handlers for pulmonary tuber- 
culosis 5 
11. Ample dining area (12 square feet per person) 5 
C. Accommodations for Patients Total points 70 
it 1. All outside rooms—above ground level—communicating directly 
with corridor . . 5 
2. Room areas (per bed—at least 3 feet between beds') 
Private rooms 100 square feet, multiple-bed rooms 80 sq. ft., 20 
Private rooms 80 square feet, multiple-bed rooms 70 sq. ft.. .. 15 
Private rooms 70 square feet, multiple-bed rooms 60 sq. ft.. .. 10 
it No room area less than 60 square feet per bed 5 
3. Window area adequate for natural light and ventilation 5 
4. Room doors opening inward—sufficient width 5 
it 5. Good beds—plentiful supply of bedding and linen 5 
6. Space for patients’ personal effects 5 
★ 7. Privacy for patients in multiple-bed rooms 5 
it 8. Call signal convenient to each patient 5 
it 9. Beds, bed furnishings, etc., thoroughly cleaned after discharge of 
patient 5 
10. Rooms well equipped (adjustable bed, easy chair, floor lamp, lav- 
atory, etc.) and arranged for comfort and convenience of pa- 
tients 10 
D. Nursing Department Total points 55 
it 1. Ample space and facilities for cleaning and storage of equipment, 5 
2. Fixed stations for nurses 5 
3. Nurses’ rest rooms—including toilets 5 ★ 4. Equipment—enamelware, hot-water bags, thermometers, etc 5 
★ 5. Drug and medicine cabinet 5 
★ 6. Locker for narcotics—record book 5 
★ 7. Sterilizing facilities—checks on performance 10 
★ 8. Lavatories, scrub-up sinks with foot, knee, or elbow control 5 
★ 9. Supply of individual towels, bath blankets, etc 5 
★ 10. Restraints—acceptable practice in use of 5 
E. Hospital Records and Reports Total points 85 
★ 1. Medical records—meet substantially the recommendations' of Amer- 
ican Medical Association or American College of Surgeons... 40 
★ 2. Accounting system—complete record of income and disbursements, 5 
Or conforming substantially to principles' recommended by Ameri- 
can Hospital Association or other national organizations 15 
3. Statistical information records 5 
★ 4. Birth certificates filed with local registrar 5 
★ 5. Birth and death lists sent promptly to Board of Health 5 
★ 6. Death certificates secured 5 
★ 7. Unclaimed bodies reported to University of Kansas Medical Center, 5 
★ 8. Burial permits obtained for bodies disposed of in hospital 5 
Isolation of contagious disease patients or suspects 10 
G. Laboratory Total points Jfi 
★ 1. Approved by Kansas Advisory Laboratory Commission if blood 
testing for syphilis 10 
2. Autopsies performed on 15 percent or more of annual deaths.... 10 
3. Director—Certified by American Board of Pathology 10 
4. Technicians certified by Board of Registry (American Society of 
Clinical Pathologists) 10 
H. X-ray Total points Ifi 
1. Portable X-ray machine and fluoroscope 10 
2. Complete X-ray diagnostic and/or therapeutic service under qual- 
ified roentgenologist 30 
I. Personnel Total points 90 
1. Employes Per Occupied Bed (Occupied bed equals patient days' 
for 6 months' divided by 183) 
0.6 per occupied bed 3 
0.7 per occupied bed 5 
0.8 per occupied bed 10 
0.9 per occupied bed 15 
1.0 per occupied bed 20 
1.1 per occupied bed 23 
1.2 per occupied bed 25 
2. Registered Nurses 
One registered nurse per 5 occupied beds 10 
One registered nurse per 4 occupied beds 15 
One registered nurse per 3 occupied beds 20 Registered nurse (surgical training) in charge of surgical depart- 
ment 10 
Registered nurse (obstetrical training) in charge of obstetrical 
department 10 
All nursing service in charge of registered nurse 10 
3. Practical Nurses 
Qualifications and duties defined as recommended by Kansas 
Nurses’ Association 5 
4. Librarian (part-time if no more needed) 5 
5. Librarian registered by American Association of Medical Record 
Librarians 5 
J. Organization Total points 75 
1. Governing body (Board or Individual) whose duties are defined 
by written instrument (Constitution and Bylaws) 5 
2. Administrator or Executive Officer—competent and experienced- 
responsible to governing authority 10 
3. Organized Medical Staff: Written bylaws, rules, and regulations; 
assuming responsibility for all techniques involving profes- 
sional care of patients; holding regular meetings; keeping rec- 
ords of proceedings 20 
4. Approved by American College of Surgeons or registered by Amer- 
ican Medical Association; or approved or registered by other 
accredited national organization * 10 
5. Approved for Internships or Residencies by American College of 
Surgeons, American Medical Association, or by other accred- 
ited national organization 10 
6. Approved school for nurses by Kansas Board of Examination and 
Registration for Nurses 10 
7. Member of American Hospital Association or other accredited na- 
tional organization 5 
8. Member of Kansas Hospital Association or other accredited state 
organization 5 
III. MATERNITY SERVICE 
A. Nursing Total points 15 
1. Nurse or nurses giving time exclusively to maternity patients—or 
employing isolation technique if serving other patients 10 
2. Nurses examined and certified as free from communicable disease, 5 
B. Accommodations for Maternity Patients Total points 35 
1. Maternity patients segregated 10 
★ 2. Isolation room or rooms 5 
★ 3. All nonbasement rooms'; area 70 square feet or more per bed— 
larger area in multiple-bed rooms or wards; screens or curtains 
between beds in multiple-bed rooms or wards 5 
4. Section of hospital equipped for and devoted exclusively to ma- 
ternity patients 10 
5. Special labor rooms (1 per 10 obstetric beds') 5 C. Delivery Total points J+5 
1. Rooms equipped and used exclusively for delivery (1 per 20 ob- 
stetric beds) segregated from other departments 20 
★ 2. Equipment for oxygen; transfusion; anesthesia; substerilizing.... 10 
★ 3. Incubator available 5 
★ 4. Reliable method of identification of infants 5 
it 5. Surgical or spotlight available 5 
D. Provision for Infants Total points 50 
1. Special nursery for infants (adequate area per bassinet) 20 
★ 2. Formula room or area for preparation of food properly equipped, 10 
★ 3. Isolation facilities and techniques for diseased infants 5 
★ 4. Heat, ventilation, and humidity regulation 10 
5. Visiting restrictions 5 
6. Special provisions for premature infants 5 
7. Adequate work area 5 
8. Suspect nursery 5 
it 9. Terminal sterilization of feedings 5 
A. Administration Total points 28 
1. Business office and information desk 3 
2. PBX board and night information desk 5 
3. Medical record room 2 
4. Staff lounge 2 
5. Lobby 2 
6. Public toilets 3 
7. Administrator’s office 2 
8. Director of nurses office 2 
9. Admitting office 2 
10. Library, conference or board room 5 
B. Surgical Department Total points 60 
1. Major operating room 5 
2. Minor operating room 5 
3. Cystoscopy room 5 
4. Orthopedics room 5 
5. Central sterilizing room 5 
6. Instrument room 3 
7. Anesthesia room and storage 5 
8. Doctors’ lockers and showers 2 
9. Station for supervisor 5 
10. Air conditioned 5 
11. Automatic temperature control 5 
C. Emergency Department Total points 18 
1. Accident room—near ambulance entrance 10 
2. Accident room completely separated from surgical and obstetrical 
departments 3 
3. Equipment and supplies adequate for anticipated use 5 
MISCELLANEOUS D. Out-patient Department Total points 24 
1. Easily accessible—on ground floor if possible 5 
2. Convenient to X-ray, laboratory, etc 5 
3. Waiting room and toilets available 3 
4. Social service and screening room 5 
5. Examining room 3 
6. Dental unit 3 
E. Special Bed Allocation 
1. Beds devoted primarily to care of: Total points 40 
a. Chronic diseases 10 
b. Early tuberculosis 10 
c. Early mental disorders 10 
d. Contagious diseases 10 
F. Employes’ Facilities Total points 30 
1. For nurses (if no nurses’ home); locker rooms', showers, rest rooms, 
toilet in main building.. 10 
Or nurses’ home 15 
2. Nurses’ rest rooms and toilet on each floor 5 
3. For other employes—available locker rooms, toilets, showers, rest 
rooms 10 
G. Adjunct Diagnostic and Tteatment Facilities Total points 60 
1. Radiology—under direction of qualified radiologist 5 
2. Physical Therapy—with qualified technician—and adequate equip- 
ment 5 
3. Anesthesia—organized department under direct supervision of a 
competent medical anesthetist 5 
4. Electrocardiography—adequate equipment—supervised by physi- 
cian trained in cardiology, competent technician. 5 
5. Oxygen Therapy—under supervision of member of medical staff 
with knowledge of apparatus and scientific principles of the 
therapy 10 
6. Pharmacy—with registered pharmacist 10 
7. Occupational Therapy—trained technican 5 
8. Dental Department—a complete and self-contained unit organized 
on par with other departments 10 
9. Cancer Clinic 5 
H. Insurance Coverage: (1) Fire, lightning, tornado; (2) steam boiler; 
(3) workmen’s compensation; (4) public liability 5 VII. Hospital Licensure Law 
Chapter 329, Laws of Kansas, 1947 
An Act relating to hospitals; providing for the licensing, inspection and regu- 
lation thereof; creating a hospital advisory council and prescribing its powers 
and duties; authorizing the promulgation of rules' and regulations and pro- 
viding enforcement procedures for carrying out the provisions of the act; 
and providing penalties for the violation thereof. 
Be it enacted by the Legislature of the State of Kansas: 
Section 1. Definitions. As used in this act: (a) “Hospital” means a place 
devoted primarily to the maintenance and operation of facilities for the diag- 
nosis, treatment or care for not less than twenty-four hours in any week of four 
or more nonrelated individuals suffering from illness, disease, injury, or de- 
formity, or a place devoted primarily to providing for not less than twenty-four 
hours in any week of obstetrical or other medical or nursing care for four or 
more nonrelated individuals. The term “hospital” shall include public health 
centers, but shall not include maternity homes or institutions primarily devoted 
to domiciliary care, such as boarding homes and homes for the aged or to 
homes or institutions which, as an exercise of religious freedom, are conducted 
in conformity with the practice of the religious tenets of any church in the 
ministration to the sick or suffering by spiritual means', and provided that 
quarantine regulations relating to contagious diseases are not infringed upon. 
(b) “Person” means any individual, firm, partnership, corporation, company, 
association, or joint stock association, and the legal successor thereof, (c) 
“Governmental unit” means the state, or any county, municipality, or other 
political subdivision thereof; or any department, division, board or other agency 
of any, of the foregoing. (d) “Licensing agency” means the state board of 
health. 
Sec. 2. Purpose. The purpose of this act is to provide for the develop- 
ment, establishment and enforcement of standards: (1) For the care and 
treatment of individuals in hospitals; and (2) for the construction, maintenance 
and operation of hospitals, which, in the light of advancing knowledge, will 
promote safe and adequate treatment of such individuals in hospitals. 
Sec. 3. Licensure. After July 1, 1948, no person or governmental unit, 
acting severally or jointly with any other person or governmental unit shall 
establish, conduct or maintain a hospital in this state without a license under 
this law. 
Sec. 4. Application for license. An application for a license shall be made 
to the licensing agency upon forms provided by it and shall contain such in- 
formation as the licensing agency reasonably requires, which may include 
affirmative evidence of ability to comply with such reasonable standards, rules 
and regulations as are lawfully prescribed hereunder. 
Sec. 5. Issuance and renewal of license. Upon receipt of an application 
for license, the licensing agency shall issue a license provided the applicant and 
the hospital facilities meet the requirements established under this act. A 
license, unless suspended or revoked, shall be renewable annually without 
charge upon the filing by the licensee, and approval by the licensing agency, of 
an annual report upon such uniform dates and containing such information in 
HOUSE BILL NO. 67 such form as the licensing agency prescribes by regulation. Each license shall 
be issued only for the premises and persons or governmental units named in 
the application and shall not be transferable or assignable except with the 
written approval of the licensing agency. Licenses shall be posted in a con- 
spicuous place on the licensed premises. 
Sec. 6. Denial or revocation of license; hearings and review. The licensing 
agency after notice and opportunity for hearing to the applicant or licensee is 
authorized to deny, suspend or revoke a license in any case in which it finds 
that there has been a substantial failure to comply with the requirements estab- 
lished under this law. Such notice shall be effected by registered mail, or by 
personal service setting forth the particular reasons for the proposed action 
and fixing a date not less than thirty days from the date of such mailing or 
service, at which the applicant or licensee shall be given an opportunity for a 
prompt and fair hearing. On the basis of any such hearing, or upon default 
of the applicant or licensee, the licensing agency shall make a determination 
specifying its findings of fact and conclusions of law. A copy of such determi- 
nation shall be sent by registered mail or served personally upon the applicant 
or licensee. The decision revoking, suspending or denying the license or appli- 
cation shall become final thirty days after it is so mailed or served, unless the 
applicant or licensee, within such thirty-day period, appeals the decision to the 
advisory council provided in section 10 of this act which shall convene within 
fifteen days after such appeal and may affirm, modify or reverse such decision 
or grant the licensee a period of time not exceeding one year in which the 
licensee shall make such changes as are neces'sary to comply with the require- 
ments established under this act, or may grant a conditional license to an appli- 
cant for a period not exceeding one year which conditional license shall auto- 
matically terminate on the date fixed unless the applicant shall, before such 
date, comply with the requirements established under this act. Any decision 
of the advisory hospital council revoking, suspending, or denying the license 
or application shall become final thirty days after it is mailed or served, unless 
the applicant or licensee appeals as provided in section 14 of this act. The 
procedure governing hearings authorized by this1 section shall be in accordance 
with rules promulgated by the licensing agency with the approval of the ad- 
visory hospital council. A full and complete record shall be kept of all pro- 
ceedings, and all testimony shall be reported but need not be transcribed unless 
the decision is appealed pursuant to section 14 hereof. A copy or copies of 
the transcript may be obtained by any interested party on payment of the cost 
of preparing such copy or copies. Witnesses may be subpoenaed by either party. 
Sec. 7. Rules, regulations, and enforcement. The licensing agency subject 
to the approval of the advisory hospital council, shall adopt, amend, promulgate 
and enforce such rules, regulations and standards' with respect to all hospitals 
or different types of hospitals to be licensed hereunder as may be designed to 
further the accomplishment of the purposes of this law in promoting safe and 
adequate treatment of individuals in hospitals' in the interest of public health, 
safety and welfare: Provided, That no rule or regulation shall be made by the 
licensing agency which would discriminate against any practitioner of the heal- 
ing art who is licensed to practice in this state: Provided further. That boards 
of trustees or directors of institutions licensed pursuant to the provisions of this 
act shall have the right to select the professional staff members of such institu- 
tions and to select and employ internes, nurses' and other personnel and no rules, regulations or standards of the licensing agency shall be valid which, if 
enforced, would interfere in such selection or employment: And provided 
further. That in formulating rules and regulations, the agency shall give due 
consideration to the size of the hospital, the type of service it is intended to 
render, the scope of such service and the financial resources in and the needs 
of the community which such institution serves. 
Sec. 8. Effective date of regulations. Any hospital which is in operation 
at the time of promulgation of any applicable rules or regulations or minimum 
standards under this act shall be given a reasonable time, under the particular 
circumstances not to exceed two years from the date of such promulgation, 
within which to comply with such rules and regulations and minimum standards. 
Sec. 9. Inspections and consultations. The licensing agency shall make or 
cause to be made such inspections and investigations as it deems necessary. 
The licensing agency may prescribe by regulations that any licensee or appli- 
cant desiring to make specified types of alterations or additions to its facilities 
or to construct new facilities shall before commencing such alteration, additon 
or new construction, submit plans and specifications therefor to the licensing 
agency for preliminary inspection and approval or recommendations with re- 
spect to compliance with the regulations and standards herein authorized. 
Necessary conferences and consultations may be provided. 
Sec. 10. Advisory hospital council. The governor shall appoint an advisory 
hospital council to advise and consult with the licensing agency in carrying out 
the administration of this act. The council shall consist of nine members as 
follows: Three representatives of the Kansas hospital association; two members 
of the medical profession; one registered nurse who shall be a member of the 
Kansas state nurses1’ association; and three persons representative of users of 
the hospital services, one of whom shall be the state chairman of the subscriber's 
council of the Kansas hospital service association, inc. The secretary of the 
state board of health shall be ex officio secretary of such council. The council 
shall, annually, elect from its own membership a chairman. Each member shall 
hold office for a term of four years, except that any member appointed to 
fill a vacancy occurring prior to the expiration of the term for which his prede- 
cessor was1 appointed shall be appointed for the remainder of such term and 
the terms of office of the members first taking office shall expire, as designated 
at the time of the appointment, two at the end of the first year, two at the end 
of the second year, two at the end of the third year, and three at the end of the 
fourth year after the date of appointment. Council members while serving on 
the business of the council shall receive necessary travel and subsistence ex- 
penses while so serving away from their place of residence. The council shall 
meet as frequently as the chairman deems necessary, but not less' than once 
each year. Upon request by three or more members, it shall be the duty of the 
chairman to call a meeting of the council. 
Sec. 11. Functions of advisory hospital council. The advisory hospital 
council shall have the following responsibilities’ and duties: (a) To supervise 
and direct the licensing agency in matters of policy affecting administration of 
this act, and in the development and approval of rules, regulations and stand- 
ards provided for hereunder. (h) To review on appeal of a licensee or ap- 
plicant any order of the licensing agency revoking, denying or suspending a 
license and to affirm, modify or reverse such order. 
Sec. 12. Information confidential. Information received by the licensing agency through filed reports, inspections, or as otherwise authorized under this 
act, shall not be disclosed publicly in such manner as to identify individuals or 
hospitals, except in a proceeding involving the question of licensure. 
Sec. 13. Annual report of licensing agency. The licensing agency shall 
prepare and publish an annual report of its activities and operations under this 
law. 
Sec. 14. Judicial review. Any applicant or licensee aggrieved by the deci- 
sion of the advisory hospital council may, within thirty days after the mailing 
or serving of notice as provided in section 6 of this act, appeal to the district 
court of the county in which the hospital is located or is to be located. The 
district court shall try the appeal de novo and shall have the jurisdiction to 
affirm, modify, vacate or reverse the decision complained of. Notice of said 
appeal shall be filed in the office of the clerk of the district court and a copy 
thereof served upon the licensing agency within five days thereafter. Upon 
the filing of said appeal, the licensing agency shall, within twenty days, file 
with the clerk of the district court all records of the licensing agency and ad- 
visory hospital council in the case, including the evidence taken at the pro- 
ceedings. Either the applicant, licensee, licensing agent, or the state may apply 
for such further review as is provided by law in civil cases for appeals to the 
supreme court. Pending a final disposition of the matter, the status quo of the 
applicant or licensee shall be preserved except as the court otherwise orders in 
the public interest. 
Sec. 15. Penalties. Any person establishing, conducting, managing, or op- 
erating any hospital without a license under this law shall be guilty of a mis- 
demeanor, and upon conviction shall be fined not more than one hundred 
dollars for the first offense and not more than fifty dollars for each subsequent 
offense, and each day of a continuing violation after conviction shall be con- 
sidered a separate offense. 
Sec. 16. Injunction. Notwithstanding the existence or pursuit of any other 
remedy, the licensing agency may, in the manner provided by law, upon the 
advice of the attorney general who shall represent the licensing agency in the 
proceedings maintain an action in the name of the state for injunction or other 
process against any person or governmental unit to restrain or prevent the 
establishment, conduct, management or operation of a hospital without a li- 
cense under this law. 
Sec. 17. Severability. If any provision of this act or the application thereof 
to any person or circumstance shall be held invalid, such invalidity shall not 
affect the provisions or application of this act which can be given effect without 
the invalid provision or application, and to this end the provisions of the act 
are declared to be severable. 
Sec. 18. This act shall take effect and be in force from and after its pub- 
lication in the statute book. 
Approved April 8, 1947. 
Published in Statute Book June 30, 1947. 
PRINTED BY 
FERD VOILAND. JR.. STATE PRINTER 
TOPEKA. KANSAS 
1949 
23-522